POS1000 MORE THAN 30 % OF WOMEN WITH SPONDYLOARTHRITIS HAVE AN UNFAVORABLE PREGNANCY OUTCOME MOST FREQUENTLY DUE TO SMALL FOR GESTATIONAL AGE: ANALYSIS OF THE PROSPECTIVE GR2 COHORT
Authors: S. Hamroun, M. Couderc, R. M. Flipo, J. Sellam, C. Richez, R. Belkhir, L. Gossec, H. Marotte, E. Dernis, A. Frazier-Mironer, E. Gervais, C. Lukas, V. Devauchelle-Pensec, L. Dunogeant, A. Deroux, N. Costedoat-Chalumeau, A. Moltó
Journal: Annals of the Rheumatic Diseases (2022)

Background Spondyloarthritis (SpA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age 1 . However, there is limited knowledge about the impact of the disease and its treatment on pregnancy. Objectives The aim of the study was to determine the factors associated with adverse pregnancy outcome in women with SpA. Methods All SpA patients (diagnosis according to the Rheumatologist) included in the national multicenter GR2 cohort from 2015 to June 2021 were included in the analysis. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy (&lt;12 weeks of gestation). The main endpoint was favorable pregnancy outcome, a composite outcome defined as a live birth at term ≥ 37 gestation weeks of a healthy newborn with a weight greater than the 10th percentile. We performed a multilevel logistic regression model, in which we considered patient and center random effects (patient random effect for some women included in the cohort two times). Disease activity was defined by a BASDAI score ≥ 4 at least once during pregnancy. We used a multiple imputation to address missing data among the explanatory variables. Results are presented as an odds ratio (OR) with confidence interval (CI). Results Among the 207 pregnancies in women with SpA included in the GR2 cohort, 126 were retained for analysis of obstetrical outcome. Of these, 29 (23.0%), 14 (11.1%), 69 (54.8%) were exposed to corticosteroid, NSAID and biologics at least once during pregnancy, respectively. An active disease at least once during pregnancy was found in 47 (37.3%) pregnancies. A live birth was found in 116 (92.1%) women, including 110 (87.3%) full-term births. Early miscarriages and stillbirths were observed in 7 (0.06%) and 3 (0.02%) women, respectively. A caesarean section was performed in 20 (17.2%) cases. A favorable pregnancy outcome was found in 80 (63.5%) of the women. Unfavorable pregnancy outcome was most frequently due to small for gestational age, observed in 22 (19%) pregnancies. The multivariate model adjusted for age, BMI, nulliparity, active disease during pregnancy, smoking, and exposure to NSAIDs and corticosteroids during pregnancy found an association between unfavorable pregnancy outcome with nulliparity (OR 2.63 95% CI [1.01-6.81] p = 0.05). Conclusion This study provides original results on pregnancy in women with SpA. It found a favorable pregnancy outcome in 63.5% of women. Unfavorable pregnancy outcome was most frequently due to small for gestational age, which should lead to a coordinated management with obstetricians for the follow-up of pregnancy in women with SpA. References [1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64. Table 1. Multilevel logistic regression model: factors associated with unfavorable pregnancy outcome in women with SpA. Univariate analyses Multivariate analyses Crude OR 95% CI p Adjusted OR 95% CI p Age 1.01 [0.92-1.10] 0.859 1.05 [0.95-1.17] 0.297 BMI 0.99 [0.91-1.07] 0.796 0.99 [0.90-1.08] 0.747 Nulliparity 2.16 [0.94-4.94] 0.071 2.63 [1.01-6.81] 0.049 Smoking 0.84 [0.23-3.03] 0.805 0.84 [0.22-3.21] 0.805 Disease activity* 0.98 [0.40-2.43] 0.964 1.15 [0.43-3.07] 0.778 Corticosteroids** 1.09 [0.45-2.65] 0.876 1.15 [0.51-2.71] 0.902 NSAIDs** 0.65 [0.18-2.33] 0.196 0.67 [0.18-2.56] 0.565 * BASDAI score ≥ 4 at least once during pregnancy. ** Use at least once during pregnancy Acknowledgements The GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB. Disclosure of Interests SABRINA HAMROUN: None declared, Marion Couderc: None declared, Rene-Marc Flipo: None declared, Jérémie SELLAM: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Rakiba Belkhir: None declared, Laure Gossec: None declared, Hubert MAROTTE: None declared, Emmanuelle Dernis: None declared, Aline Frazier-Mironer: None declared, Elisabeth Gervais: None declared, Cédric Lukas: None declared, Valerie Devauchelle-Pensec: None declared, Laëtitia Dunogeant: None declared, Alban Deroux: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared